Category Archives: Affordable Care Act (ACA)
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
“It is a truism that healthy children are in a better position to learn in the classroom.
Unfortunately, it’s also a sad fact of life that the role of a school nurse—who is on campus to help insure students’ well-being—often goes overlooked or underestimated.”
--Editorial, Board Should Work to Remedy Nursing Shortage, Burbank Leader, April 11, 2014
“Our goal is not just to be at the table [of policy-making discussions]. We need practiced, experienced nurses to vote at that table, and when our voices are heard, the patient’s voices are heard, and this means we must invest more time, attention, and resources to develop nurse leaders.”
--Karen Daley, PhD, RN, FAAN, president, American Nursing Association, Nursing Leaders Essential in Providing Quality Health Care, Houston Chronicle, April 4, 2014
“I have watched the industry grow over the years as nurses become more involved than just taking vital signs, giving medications and bathing patients. There is a more team-oriented approach, which has developed in hospitals, and this naturally makes it a more rewarding career option. As a result, more and more nursing programs are in demand.”
--Brenda McAllister, MSN, EdD, director of nursing, EDMC-Brown Mackie College, Health Care Industry Experiencing New Demands for Nurses, (Milwaukee) Journal Sentinel, April 3, 2014
Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics.
In these early days of the Affordable Care Act, the uninsured rate has begun to sharply decrease. One recent estimate suggests 5.4 million adults gained insurance coverage in the first quarter of 2014. The Congressional Budget Office projects that enrollment in Medicaid and the health insurance Marketplaces will increase even more rapidly over the next two years.
The importance of increased health insurance coverage for improved access to health care justifiably receive much of the public’s attention, but the impact of coverage on the financial health of families may be equally important. Subsidized health insurance can increase the disposable income of families by freeing up money that was previously used to pay out-of-pocket for doctor’s visits and prescription drugs. Newly insured individuals also benefit from the risk-protection of health insurance since even people who use little or no health care are at risk of unexpected accidents or newly diagnosed diseases.
A recent study in Oregon that compared adults who received free health insurance through a lottery to those who applied but did not receive the free care found that the “winners” were much less likely to say that they needed to cut back on necessities to pay for health care. They also had much less medical debt and a lower likelihood of receiving a notice from a collection agency.
Nurses are “the backbone of efforts” to expand New Mexico’s primary care workforce, according to Gov. Susana Martinez, and they help ensure that people living in the state’s rural and underserved communities can get the high quality care they need and deserve. A video from the governor helped open the Robert Wood Johnson Foundation Academic Progression in Nursing meeting in Washington, D.C., this week, which brought together nurse leaders from around the country. In her remarks, Governor Martinez explains why New Mexico has implemented a common statewide nursing curriculum, made it easier for nurses in the state to further their education, and placed “a strong emphasis on nurses.”
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
“There has been tremendous growth in the nurse-managed health clinics, especially prior to the Affordable Care Act implementation, but certainly also now. I would go as far [as] to say that we won’t have a successful implementation of the Affordable Care Act if we don’t utilize nurse practitioners in primary care roles.”
--Tine Hansen-Turton, MGA, JD, CEO, National Nursing Centers Consortium, Nurse-Led Clinics: No Doctors Required, Marketplace Healthcare, March 5, 2014
“A lack of representative educators may send a signal to potential students that nursing does not value diversity. Students looking for academic role models to encourage and enrich their learning are often frustrated in their attempts to find mentors and a community of support. Clearly, we have a mandate to support and encourage nurses from minority groups in their quest to seek advanced degrees and to assume leadership roles in nursing education.”
--Jane Kirschling, PhD, RN, FAAN, president, American Association of Colleges of Nursing, Diversity in Nursing Education, Advance for Nurses, February 26, 2014
“The question for every nurse and every hospital board is how you go about promoting transformational change in which the emphasis is not on transitory, isolated performance improvements by individuals, but on sustained, assimilated, comprehensive change of the whole ... this report offers one answer: nurse leaders knowledgeable about how information technology can help redesign practices so that they are standardized, evidence-based and clinically integrated, and reinforce the values of a caring culture.”
--Angela Barron McBride, PhD, RN, FAAN, author of The Growth and Development of Nurse Leaders, TIGER Releases Study Aimed at Enhancing Nursing Informatics Education, Advanced Healthcare Network for Nurses, February 24, 2014
An interview with Nicole Lurie, MD, MSPH, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. She is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
Human Capital Blog: You write that the nation’s emergency care system is in trouble. What are the challenges facing emergency departments (EDs)?
Nicole Lurie: We’ve understood for at least a decade that the emergency system is in trouble. We ask a lot of this system, and as a result we have EDs that are really crowded and with long wait times, boarding times and throughput times. It’s become a de facto access point for many people who lack access to primary care or insurance, which wasn’t what it was originally set up for. Now, EDs have evolved to be more than places to treat life and limb threats and serve as default diagnostic and therapeutic entry points. But many people who end up in an emergency department may be willing to be treated in a different kind of environment. It is really up to us to build a system that accommodates their needs and ensure our emergency care system can do its important work.
And remember: We changed the way we deliver care in the U.S. from a hospital-based focus to an outpatient focus over the last few decades, but we never really built the infrastructure for it. Outpatient providers have had their visits shortened and group practice environments have changed the relationship between patients and their primary care providers. We hear about the shortage of primary care providers and the crisis of crowding and boarding in emergency departments, but we don’t always connect the dots to understand how we got here. It is a good time to start to have this conversation as payment models are encouraging us to recognize that generating health for our patients is a team effort.
HCB: How do you see the emergency care system evolving, particularly with respect to disaster preparedness?
Nicole Lurie, MD, MSPH, is the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services (HHS), and Kacey Wulff, MPH, is special assistant to the assistant secretary, at HHS. An alumna of the Robert Wood Johnson Foundation Clinical Scholars program, Lurie is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. This is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
As we approach the Affordable Care Act’s March 31 enrollment deadline, data is starting to emerge about how these reforms are making care more accessible, cost less, and, ultimately, Americans healthier. As these reforms take effect, and make our day-to-day health care system stronger, they also result in strengthening communities across the country to become more resilient and disaster-ready.
The gaps that inspired and propelled health reform like untreated chronic conditions and mental illness, and health disparities plague our health care system every single day. During a crisis, like a hurricane, earthquake, or attack, these issues can become magnified. As a result, the ability for individuals and communities to prepare, respond, and recover successfully is intrinsically linked to the strength of the underlying health care system.
The Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 60 million Americans. As a result, many Americans who previously have not had coverage for mental health care will have greater access to this and other important aspects of health care. This will help to make the tools that support recovery from injuries sustained during disasters, whether illness, injury, or trauma, more accessible.
This boost in preparedness is important for responding to disasters big and small: the biggest indicator of how a person or community will fare during a disaster is how they were doing before the crisis struck. While health insurance doesn’t guarantee that you will be healthier, it does make health much more likely.
Sue No, RN, BSN, is a fellow in the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico (2013-2017). She is working toward her PhD in nursing with a concentration in health policy. This post is part of the “Health Care in 2014” series.
Every New Year brings New Year’s resolutions. It is a time for reflection on years past and to develop actionable changes needed for a hopeful and productive new year. Clearly 2014 is no exception. With the New Year already in full swing, I encourage people—yes, this also includes you, Generation Y—to enroll in a health insurance plan and take advantage of the Affordable Care Act’s (ACA) current and new coverage opportunities in an effort to advance our nation’s culture of health.
You might be asking yourself a few questions such as: Who is Generation Y and why are they important? I am happy to provide answers.
The largest generation, Generation Y, or Millennials, consists of young adults born between 1977 and 1994. This important demographic is key to obtaining a sustainable health care exchange system with affordable insurance plans. Healthy Millennials must enroll in the marketplace to offset the high costs acquired by the disproportionate number of Americans with high medical costs. Unfortunately, only a small number of young adults have participated in the health care exchange since open enrollment. This isn’t surprising.
This is part of the February 2014 issue of Sharing Nursing’s Knowledge.
“As an ADN-prepared nurse returning to school, I have been confronted with the formidable gap between the current reality of professional nursing and the push to elevate the level and scope of practice in the face of a projected nursing shortage. I have no doubt that higher levels of education, certification, and experience have the potential to create better nurses and in turn safer environments for our patients, but I do have to question whether the infrastructure necessary to support these changes is in place.”
--Eric Deane, RN, Charlottesville, Va., Thoughts on Entry to Practice, Nurse.com, February 10, 2014
“As medical professionals we are recognizing that on a national level, advanced practice nurses [APNs] are part of the solution to the health care access crisis. The only way that patients are going to get the care they need is if all parts of the medical team, including APNs, midwives, physician’s assistants, physicians, and others, come together as partners. It’s not that nurse practitioners are going to replace any other clinicians. That’s not our goal. But advanced practice nurses are extraordinarily well prepared to provide primary care. They are trained in managing multiple types of health problems and in promoting a healthy lifestyle. With the current challenges in patient care, I can only see the role of the nurse practitioner increasing.”
--Ivy Alexander, PhD, APRN, FAAN, clinical professor and director of advanced practice programs, University of Connecticut School of Nursing, An Expanding Role for Nurse Practitioners, Medical Xpress, February 5, 2014
“More needs to be done to help spread awareness [about the Affordable Care Act]. This is one of the things nurses do best. They educate.”
--Mary Wakefield, PhD, RN, FAAN, administrator, Health Resources & Services Administration, Nurses Step Out to Help with ACA Enrollment, Nursezone.com, January 31, 2014
Jay Himmelstein, MD, MPH, is a professor of family medicine and community health and chief health policy strategist at the Center for Health Policy and Research at the University of Massachusetts Medical School (UMMS). He serves as a senior advisor to the UMMS Office of Policy and Technology, and is a senior Fellow in health policy at NORC, University of Chicago. Himmelstein is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program, where he worked on the health staff of Senator Edward Kennedy. This post is part of the “Health Care in 2014” series.
The nation's attention has focused in recent months on the politics and challenges related to the roll-out of state and federal health insurance marketplaces created by the Affordable Care Act (ACA). Despite website technical woes, significant numbers of Americans have already gained access to affordable insurance plans through the marketplaces and other provisions of the ACA, and it appears likely that the ‘marketplace’ concept will be successful over time in connecting consumers to health insurance and significantly decreasing the ranks of uninsured.
The better functioning marketplaces currently allow consumers to: 1) determine eligibility for subsidized health insurance, 2) use basic online shopping tools to compare and purchase health insurance plans based on four different "metallic tiers" (i.e., the platinum, gold, silver, and bronze tiers), and 3) make side-to-side comparisons between these plans on features such as deductibles, out-of-pocket cost limits, and number and proximity of doctors and hospitals. A few marketplaces also offer information about plan quality, the ability to search for health care providers and hospitals associated with specific plans, and rudimentary ‘cost calculators’ which estimate the total cost of plans inclusive of premiums, deductibles, and out-of-pocket costs.
Michael Geruso, PhD, is a Robert Wood Johnson Foundation Scholar in Health Policy Research at Harvard University and an assistant professor of economics at the University of Texas at Austin. This post is part of the “Health Care in 2014” series.
2014 marks the start of coverage for those who are newly insured via the health insurance exchanges. In general, healthy behaviors and lifestyle are probably the most important inputs to health, especially for those of us free of serious chronic conditions. But for those of us who are sick, quality health care and access to drugs is crucial for health and happiness. We will soon know to what extent the health insurance exchanges have overcome their implementation problems and have connected previously uninsured Americans to health care.
When markets for health insurance work efficiently, they can deliver access to crucial health services to those who need and want them most. Unfortunately, free, unregulated markets for health insurance rarely function efficiently. The market failures in health care have long been noted by economists, most famously by Nobel Prize winner Kenneth Arrow, MA, PhD. In my view, one the most important changes that the Affordable Care Act (ACA) brings with it is an attempt to address and correct market failures via the exchanges.